England could have one of the lowest disease burdens of any developed country in the world if equalities were addressed so that levels of health in its worst performing regions matched the best ones, a Lancet-published study led by Public Health England has found.

Between 1990 and 2013, life expectancy in England jumped 5.4 years to 81.3 years, marking one of the biggest increases compared with its European peers, largely because of less deaths from cardiovascular disease, stroke, chronic obstructive pulmonary disease and some cancers.

As a whole England outperforms the comparative European average for disease burden - years of life lost to death and lived with disability - but in the country there remains a huge divide between areas of least and most deprivation. 

“Life expectancy in 2013 for those living in the most deprived areas was still lower than those in less deprived areas enjoyed in 1990,” noted Adam Briggs, co-author and Wellcome Trust Research Training Fellow, University of Oxford. “How deprived you are is the key driver of these differences rather than where you live and therefore deprivation and its causes need to be tackled wherever they occur.”

Huge opportunity

Posing a huge opportunity for improving public health, preventable risk factors together explain 40% of ill health in England, with unhealthy diet and tobacco the two largest contributors (diet accounts for 10.8% of total disease burden and tobacco 10.7%), underlining the potential of better lifestyle choices.

The research also found that improvements in life expectancy haven’t been matched by improvements in levels of ill-health, which means that the population is living longer but spending more time ill. For example, with diabetes, the years of life lost to the disease have dropped 56%, but years living with disability have leapt by more 75%, the study found.

“People are living longer, but they are living longer with disability, which will require more integrated models of care spanning health and social services,” noted Kevin Fenton, Director of Health and Wellbeing at PHE.

“Health policies must address the causes of ill health as well as those of premature mortality,” the study authors conclude. “Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation”.